In 1997, Tony Blair told voters they had 24 hours to save the NHS. But it took him several years in government to realise what the rescue would entail. There was no masterplan like the one for education. Frank Dobson, Blair's first health secretary, had no routemap when he set about abolishing the internal market, the Conservatives' scheme for creating competition among NHS hospitals.

A different strategy emerged in 2000, when Alan Milburn, Dobson's successor, produced a 10-year plan for NHS reform, and in 2002, when Gordon Brown willed the resources to pay for it. But the government did not say it was aiming to restore "competition" until Patricia Hewitt, Blair's fourth health secretary, dared to use the word in December 2005.

Downing Street advisers would now concede the government went on a long detour before it discovered a liking for market forces in the NHS - including the use of private clinics to treat patients on the waiting list.

Few of the reforms required legislation. An exception was the bill giving independent foundation status to successful NHS hospitals. That scraped through the Commons after one of the biggest Labour backbench revolts of the second term. But Blair's legacy does not include winning over his party to his version of NHS reform.

The biggest change for the NHS was a huge injection of money; Brown raised national insurance to fund it. This year, the NHS will spend three times as much as in 1996/7. Over the same period, spending on education (Blair's "number one priority") merely doubled. In 1997, patients could wait two years or more for treatment. By the end of next year the maximum time from GP referral to operating theatre will be 18 weeks. Thousands of lives are being saved by improvements in the treatment of cancer and heart disease. Staffing and salaries have increased.

But the government reaped little political reward. Polling shows recent users of the NHS appreciate an improvement in service, but think they must have been lucky exceptions. Although Conservative policies on the NHS are still sketchy, the voters seem to prefer them.